摘要
目的 探讨对血栓形成高度敏感的血栓前体蛋白 (thrombus precursor protein,TPP) ,在伴有心房颤动(atrial fibrillation,Af)的心脏机械瓣膜置换术患者术后抗凝监测中的意义。 方法 将 90例二尖瓣机械瓣置换术后抗凝患者根据是否伴有 Af分为 Af组 (4 5例 )、窦性心律组 (SR组、4 5例 ) ,2 0例非心瓣膜疾病的其他心脏病患者作对照 (对照组 ) ,观察比较三组的血浆 TPP浓度和国际标准化比率 (International Norm alized Ratio,INR) ,根据血浆TPP浓度将 Af患者分为三组 ,分析、比较其 INR和血浆 TPP浓度。 结果 心瓣膜置换术后 SR组和 Af组的血浆TPP浓度低于正常对照组 (P<0 .0 5 ,<0 .0 1) ,INR则高于对照组 (P<0 .0 1) ;Af组的血浆 TPP浓度高于 SR组 (P<0 .0 5 ) ;Af组患者的 INR存在与血浆 TPP浓度和患者临床表现不相符合的情况。 2 8例 Af患者的血浆 TPP浓度低于6 μg/ m l(4 .2 9± 0 .75 μg/ ml) ,血栓栓塞危险性低 ,无出血现象 ,其抗凝效果满意 (INR2 .10± 0 .73)。该组患者的 INR95 %可信区间为 1.90～ 2 .30。 结论 伴有 Af的心瓣膜置换患者可能有更高的血栓栓塞危险 ,INR在 1.90～ 2 .30之间 ,且血浆 TPP浓度在 2 .84～ 6 .0 0 μg/ m l之间可能是
Objective To explore the role of thrombus precursor protein(TPP) in the monitoring of anticoagulation in the patients with atrial fibrillation (Af) after mechanical heart valve replacement, and suggest the reasonable anticoagulant range. Methods Ninety patients were divided into Af group (n=45), sinus rhythm group (SR group, n=45), and control group (20 patients with non-valvular heart diseases), according to whether Af exist after mitral valve replacement. TPP concentrations and International Normalized Ratio(INR) in the anticoagulant patients were analyzed. Results In patients after mechanical mitral valve replacement, plasma TPP concentrations in both SR group and Af group were lower than that in control group (P<0.05,0.01), their INR value were higher than that in control group (P<0.01), and Af group had higher plasma TPP concentrations than that in SR group((P<)0.05). It was found that there existed contradictions between INR and plasma TPP concentrations in Af group. There were 28 patients with plasma TPP concentrations below 6 μg/ml and without spontaneous bleeding complications in the group with Af, who might be at the optimal anticoagulant status. Their 95% confidence of INR value was 1.90-2.30 and their plasma TPP concentration was 4.29±0.75μg/ml. Conclusion Patients with Af after mechanical heart valve replacement might have higher risk of thromboembolism, INR between 1.90 - 2.30 and plasma TPP concentration between 2.84-6.00 μg/ml might be the optimal anticoagulant therapeutic range.
出处
《中国胸心血管外科临床杂志》
CAS
2004年第3期179-182,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
血栓前体蛋白
心房颤动
心瓣膜置换术
抗凝监测
TPP
AF
Atrial fibrillation
Anticoagulation
Mechanical heart valve replacement
Thrombus precursor protein
